Newborn OMT Module

rawsulkyInternet και Εφαρμογές Web

11 Δεκ 2013 (πριν από 3 χρόνια και 7 μήνες)

88 εμφανίσεις

Newborn OMT Module



American College of
Osteopathic
Pediatricians


Robert Hostoffer,
DO,FACOP, FAAP

edited by

Eric Hegybeli, DO,
FACOP

Background:

Andrew Taylor Still, was born in Virginia in 1828, the son of a
Methodist minister and physician. At an early age, Still decided to
follow in his father's footsteps as a physician. After studying medicine
and serving an apprenticeship under his father, Still became a licensed
M.D. in the state of Missouri. Later, in the early 1860's, he completed
additional coursework at the College of Physicians and Surgeons in
Kansas City, Missouri. He went on to serve as a surgeon in the Union
Army during the Civil War.


Background:


After the Civil War and following the death of three of his
children from spinal meningitis in 1864, Still concluded that the
orthodox medical practices of his day were frequently
ineffective, and sometimes harmful. He devoted the next ten
years of his life to studying the human body and finding better
ways to treat disease.

Background:

His research and clinical observations led him to believe that the
musculoskeletal system played a vital role in health and
disease and that the body contained all of the elements needed
to maintain health, if properly stimulated. Still believed that by
correcting problems in the body's structure, through the use of
manual techniques now known as osteopathic manipulative
treatment, the body's ability to function and to heal itself could
be greatly improved. He also promoted the idea of preventive
medicine and endorsed the philosophy that physicians should
focus on treating the whole patient, rather than just the disease.


http://www.aacom.org/OM/history.html

Osteopathic Tenets
(there are 4 main
ones)



The body’s inherent ability for self
-
repair


The interrelatedness of body systems


The body possesses self
-
regulatory healing
mechanisms


The interrelatedness of structure and
function


Newborn OMT

Review of Structural Basis


Neuroembryology


Neural ridge


Neural tube







Neuroanatomy


Ventricles


Central spinal canal


Choroid plexus


CSF


Cauda equina


Dura mater


Arachnoid villi


Individual cranial bones


Skull


Review Neuroembryology


Neuroembryology


Neural ridge


Neural tube


Dematomal development



Review Neuroanatomy


Review Bones and sutures of the Skull

(make note of the difference in angle from horizontal of the
cranial base (a line from the eye socket to base of occiput)


it
is about 30 degrees in child (more horizontal) and 50 degrees
in the adult)



Pediatric

Adult

Note differences of adult and infant
skull:


Physiological Basis


Blood
-
brain barrier


Primary respiratory mechanism


Craniorhythmic impulse


Circulation of the CSF


Axes of motion in the cranium


Axonal transport


“The rule of the artery is supreme.”


Active labor, transition and delivery

Blood
-
Brain Barrier


Review CSF circulation


Developmental Relationship

Structure

Function

“Ram’s Horn” Shape

Embryologic:
CNS grows faster than cranium

Foramina:

Cranial Bones are in
multiple parts at birth (nerves
don’t poke through bones)

Suture types

for motion develop as
plates meet

Wolff’s Law:

Cartilage is laid down
along lines of stress

Osteopathy in the Cranial Field

Cranial Bone Movement


Midline:

Flexion/Extension


Paired:

External/Internal Rotation

ReminderS

Flexion (Fat Head)

Extension (Cone Head)

LATERAL

SBS Strain
(Parallelogram Head)

Common Patterns of Cranial Plagiocephaly

Cranial Somatic Dysfunction

Affects Function


Ophthalmologic


CN II, III, IV, VI


Gastrointestinal


CN IX, X, XII


Respiratory


CN X


Musculoskeletal


XI


Parasympathetics with
III, VII, IX, X

CN IX
-

Glossopharyngeal Nerve

Jugular
Foramen

CN IX
-

Glossopharyngeal Nerve


Function


Structure


Dysfunction


History


Physical examination



Motor to muscle;
Parasympathetic to glands;
Sensory to palate



Jugular foramen



Difficulties swallowing,
excessive gag reflex


Trauma to occiput &/or
temporals



Test gag reflex


Evaluation of temporals, occiput,
occipitomastoid suture


CN XI
-

Accessory Nerve

SCM

Foramen
Magnum

CN XII
-

Hypoglossal Nerve

Hypoglossal
canal

CN XII
-

Hypoglossal Nerve


Function


Structure


Dysfunction


History



Physical
examination


Motor to Tongue



Hypoglossal canal


Dysphagia, tongue function
(latch
-
suckle)



Occipital condyle trauma;

intraosseous strain



Test tongue motions


Test neonatal suck


Evaluate occiput (condyles),
top cervicals


Prevalent Pediatric Problems


Musculoskeletal System


Scoliosis


Torticollis


Respiratory System


Otitis Media (Acute vs.
Serous)


Pharyngitis


Bronchiolitis


Asthma & Reactive
Airway Disease (RAD)



Gastrointestinal System


Constipation


Poor Feeding/Sucking


GER & GERD


Neuro
-
Psycho
-
Social



Learning Disorders
(ADD/ADHD)


Strabismus

Prevalent Pediatric Problems


Musculoskeletal System


Torticollis


Scoliosis

Torticollis = Twisted Neck


Common positioning in utero


Prolonged or difficult labor
exacerbates dysfunction


Risks


Primiparous mother


LGA


Male


Breech


Multiples


Maternal uterine
abnormalities


“Back to Sleep” effect



Torticollis


SBS & CN XI


Parallelogram Pattern


Lateral Strain Deformity

Gastrointestinal System:

Poor Feeding/Sucking


Goals & Considerations


Patients present with poor growth or irritability


Prolonged or difficult labor; eventual c
-
section
preventing initial gasp


Improve restrictions impinging on responsible
cranial nerves by decompressing surrounding
sutures

Occipital Release Technique for
Newborns and Infants


Support the patient’s body by cradling it with your forearm


Support the head and palpate for motion with the ipsilateral
hand


Support the sacrum and palpate for motion with 2 or 3 fingers of
the contralateral hand


Grasp the cranium with fingers evenly splayed “as firmly as you
would a ripe tomato so as not to leave impressions”


Feel subtle release of muscles and watch newborns face
content.


Give newborn back to parent and observe improvement with
feeding.

Demonstrate the procedure on
patient in front of director

Innervation Table

Organ/System


Parasympathetic


Sympathetic


Ant.
Chapman's


Post.
Chapman's


EENT


Cr Nerves (III, VII, IX,
X)


T1
-
T4


T1
-
4,
2
nd

ICS


Suboccipital


Heart


Vagus (CN X)


T1
-
T4


T1
-
4 on L,
T2
-
3


T3 sp process


Respiratory


Vagus (CN X)


T2
-
T7


3
rd

& 4
th

ICS


T3
-
5 sp
process


Esophagus


Vagus (CN X)


T2
-
T8


---


---


Foregut


Vagus (CN X)


T5
-
T9 (Greater Splanchnic)


---


---


Stomach


Vagus (CN X)


T5
-
T9 (Greater Splanchnic)


5
th
-
6
th

ICS on
L


T6
-
7 on L


Liver


Vagus (CN X)


T5
-
T9 (Greater Splanchnic)


Rib 5 on R


T5
-
6


Gallbladder


Vagus (CN X)


T5
-
T9 (Greater Splanchnic)


Rib 6 on R


T6


Spleen


Vagus (CN X)


T5
-
T9 (Greater Splanchnic)


Rib 7 on L


T7


Pancreas


Vagus (CN X)


T5
-
T9 (Greater Splanchnic), T9
-
T12 (Lesser Splanchnic)


Rib 7 on R


T7


Midgut


Vagus (CN X)


Thoracic Splanchnics (Lesser)


---


---


Small Intestine


Vagus (CN X)


T9
-
T11 (Lesser Splanchnic)


Ribs 9
-
11


T8
-
10


Appendix






T12


Tip of 12
th

Rib


T11
-
12 on R


Hindgut


Pelvic Splanchnics (S2
-
4)


Lumbar (Least) Splanchnics


---


---


Ascending Colon



Vagus (CN X)


T9
-
T11 (Lesser Splanchnic)


R Femur @
hip


T10
-
11


Transverse Colon



Vagus (CN X)


T9
-
T11 (Lesser Splanchnic)


Near Knees


---


Descending Colon


Pelvic Splanchnic (S2
-
4)


Least Splanchnic


L Femur @ hip


T12
-
L2


Colon & Rectum


Pelvic Splanchnics (S2
-
4)


T8
-
L2


---


---


References:


Is their room for OMT therapy in your practice during the era of evidence
-
based medicine?


The Collected Papers of Viola M. Frymann, D.O.:


Legacy of Osteopathy to Children

Individual copies are priced at $75 for the hardbound edition and $65 for the softbound edition. The
shipping and handling for mail orders is $7. Orders should be sent to: AAO, 3500 DePauw
Boulevard, Suite 1080, Indianapolis, IN 46268
-
1136. Proceeds benefit the AAO and its programs.


The Viscoplastic and Viscoelastic Axes of Motionin the Cranium/Documenting Cranial
Dysfunction in Children

Print out the answer sheet to use
with the following questions.

Circle the correct answer and review
with director:


Question1: A, B, C, D, E.


Question2: A, B, C, D, E.


Question3: A, B, C, D, E.

1.
Which nerve if in dysfunction will cause
difficulties in swallowing and excessive
gag reflex:


A. CN VII


B. CN XI


C. CN XII


D. CN
IX



E. CN VI


2. Which nerve when in dysfunction will cause
dysphagia,
poor

tongue function (latch
-
suckle):


A. CN XI


B. CN XII


C. CNV


D. CN VI


E. CN VII

3. Which
pattern of Cranial Plagiocephaly
will present with a “flat head”:


A. Flexon


B. Extension


C. SBS strain


D. Torsion


E. Rotation

Certificate of Completion


I, _________________________,
successfully completed the Pediatric OMT
Module on __ __ 20__

Signatures:


Pediatric Resident ____________________


Pediatric Residency Director____________



( Please print and give to program director.)

Congratulations